EP0637971B1 - Derivation du liquide cephalo-rachidien permettant un controle invasif minimal - Google Patents

Derivation du liquide cephalo-rachidien permettant un controle invasif minimal Download PDF

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Publication number
EP0637971B1
EP0637971B1 EP93910608A EP93910608A EP0637971B1 EP 0637971 B1 EP0637971 B1 EP 0637971B1 EP 93910608 A EP93910608 A EP 93910608A EP 93910608 A EP93910608 A EP 93910608A EP 0637971 B1 EP0637971 B1 EP 0637971B1
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EP
European Patent Office
Prior art keywords
shunt
tube
shunting device
portal
valve
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
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EP93910608A
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German (de)
English (en)
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EP0637971A1 (fr
Inventor
Wolff M. Kirsh
Yong Hua Zhu
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Loma Linda University
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Loma Linda University
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
    • A61M27/002—Implant devices for drainage of body fluids from one part of the body to another
    • A61M27/006—Cerebrospinal drainage; Accessories therefor, e.g. valves

Definitions

  • the present invention relates to a shunting device for cerebrospinal fluid ("CSF") and, more particularly, to a CSF shunt which is capable of inspection and revision on a minimal invasive basis, thereby greatly reducing the pain and risk to the patient associated with previous shunt revision procedures.
  • CSF cerebrospinal fluid
  • the shunt revision can be performed on an out-patient basis, the cost of previous shunt revision surgical procedures is greatly reduced.
  • the valve regulated drainage of cerebrospinal fluid is an important neurosurgical intervention for the treatment of hydrocephalus, or "water on the brain.”
  • Hydrocephalus is caused by excess cerebrospinal fluid being located between the brain and skull.
  • hydrocephalus may result in excessive skull enlargement and, if untreated, progress to brain damage, or even death.
  • the skull is no longer flexible and the condition can cause headaches, vomiting, and loss of coordination and mental functioning.
  • Hydrocephalus is commonly treated by providing a drain tube, known as a "shunt,” between the source of the fluid within a ventricular cavity of the patient and another body cavity, such as the abdomen, chest, or vascular system (i.e., a major blood vessel, such as the jugular vein).
  • a drain tube known as a "shunt”
  • vascular system i.e., a major blood vessel, such as the jugular vein
  • a scalp incision is made and a small hole is drilled in the skull.
  • the proximal end of the shunt is installed in the ventricular cavity.
  • the distal end of the shunt is then installed in that portion of the body into which the cerebrospinal fluid is to be drained.
  • CSF shunts normally comprise a cannula or tubing system which is commonly fabricated from silastic®, a material made by Dow-Corning.
  • the ventricular or proximal end of the shunt is provided with small openings that vary from microns to millimeters in order to receive the cerebrospinal fluid into the shunt tubing.
  • the distal end of the shunt also is provided with small openings, often shaped as slits, to discharge the fluid from the shunt into the appointed body cavity.
  • the shunts usually have an internal diameter of approximately 1.5 mm and are provided with a system of valves. The valves are generally one way, only allowing fluid to pass out of the ventricular cavity.
  • Each valve is designed to open due to slight differential pressure between the inlet or proximal end of the shunt and its outlet or distal end. The valve will close in the event the pressure differential reverses, which may occur by coughing or straining of the patient, thereby preventing a reverse flow of blood or other fluid through the shunt into the ventricular cavity.
  • a typical CSF shunt is essentially L-shaped, except that it is installed in the skull of the patient in an inverted fashion.
  • the shunt is comprised of various sections of tubing which are connected together.
  • the proximal or ventricular tube is inserted directly into the skull so as to be in communication with the ventricular cavity.
  • This section of tubing is then connected, near the surface of the skull, to an elbow connector which forms a substantially 90° angle.
  • the elbow connector is in turn typically connected to another section of tubing which leads to a pump tube situated just under the skin of the skull.
  • an outlet or drain tube is connected to the pump tube which allows drainage of cerebral spinal fluid to another body cavity.
  • the elbow connector is near the "corner" of the shunt in that it conducts fluid out of the skull and down the body tangentially to the skull.
  • a portal may also be installed at the corner, just below the skin, to provide access to the shunt by a hypodermic needle. This portal allows the physician to withdraw fluid from or give injections into the ventricular cavity.
  • a shunt exhibiting the L-shaped configuration, including the function of the pump tube, is described in U.S. Patent No. 3,654,932.
  • a shunt exhibiting a portal is described in U.S. Patent No. 3,595,240, the latter disclosing the features of the preamble of claim 1.
  • the object of the invention is to provide a shunting device which can be revised on a minimal invasive basis.
  • the CSF shunt of the present invention satisfies the above-described need by providing a shunt device having an external valved access opening to permit endoscopic examination and procedural manipulation of infected or malfunctioning shunts. More specifically, the shunt of the present invention provides a valved access opening near the elbow connector of the shunt in order to permit insertion of a small angioscope or other device into the interior of the shunt. Because of the location and configuration of this access opening, the angioscope can be used to inspect both the distal and proximal regions of the shunt.
  • corrective procedures can be performed by means of the operating angioscope in order to clear the partially or completely occluded shunt or to correct valve malfunction, etc.
  • an external conduit delivery system is also provided for the shunt in which antibiotics or other therapeutic drugs can be delivered to the tissue surrounding the shunt site.
  • shunt of the present invention many substantial advantages are realized through the shunt of the present invention.
  • inspection and revision of the shunt is possible on a minimal invasive basis, thus reducing the pain and risk associated with shunt revision procedures. Since revision can be performed on an out-patient basis, the expense of previous shunt revision surgery is greatly reduced.
  • shunts will be inspected more frequently in order to anticipate and avoid life threatening situations.
  • the shunt of the present invention can also be ensured of exhibiting better performance and a longer life since revisions are more likely to occur.
  • replacement surgery will be required less often, again reducing danger and expense to the patient.
  • the pump tube is positioned just below the skin of the skull so as to be manually manipulated.
  • an elbow connector of the shunt is likewise; located near the surface of the skin.
  • a portal comprising a valved access opening is provided at the elbow of the shunt of the present invention and when the shunt is installed, the portal is situated parallel to the scalp. This portal is thus ideally situated on the bend of the elbow to permit access into the shunt in both the proximal direction toward the ventricular end of the shunt, as well as downward along the pump and/or drain tubing and distal regions of the shunt.
  • the portal can take on various configurations which will permit insertion of a suitable trocar and angioscope, and is preferably in the nature of a concave slit valve, having a portal cover.
  • An angioscope or other device can be inserted into the interior of the shunt and freely manipulated.
  • the portal is self-sealing, both preventing escape of cerebrospinal fluid and preventing entry into the shunt of outside substances.
  • the portal acts as a one-way valve.
  • the material of the portal cover is a type of silicone.
  • the concave valve is made of silastic®.
  • the slit in the concave valve can be opened by direct manual pressure transmitted through the skin. Because the portal is located at the elbow of the shunt, the concave valve is only a few millimeters under the skin surface. The exact location of the shunt may be determined using X-rays. The surgeon may open the slit in the concave valve by pressing upon the scalp in an area proximal to the concave valve.
  • the portal may be installed in tandem series to the shunt system and permits puncture through the skin by a suitable trocar.
  • a suitable cannula will serve as a guide for the angioscope.
  • a trocar can take the form of an 18-gauge needle.
  • the slit of the concave valve can first be opened manually by direct pressure transmitted through the skin.
  • An 18 gauge needle is then inserted through the scalp, portal cover, and the slit in the concave valve, and into the internal regions of the shunt.
  • a cannula is inserted over the trocar and the trocar is removed.
  • a 0.5 mm angioscope is then inserted through the cannula and into the shunt for visual inspection.
  • the angioscope permits easy visualization, for example, of the openings of the ventricular end of the shunt to determine whether or not it is blocked. Furthermore, the angioscope can be used to inspect the various tubing connections and valves to ensure proper drainage of fluid. If revision is necessary, various instruments can be inserted into the shunt through the channel of the angioscope. For example, the angioscope can be fitted with an excimer laser for the destruction of choroid plexus (the cerebrospinal fluid producing matter which often clogs the proximal end of the shunt) or other obstructive material.
  • choroid plexus the cerebrospinal fluid producing matter which often clogs the proximal end of the shunt
  • an irrigation system for the infusion of fluids and antibiotics into the interior of the shunt, or a snipping device for removing other blockage may be included on the angioscope.
  • the angioscope can also be fitted with an anemometer to determine velocity and rate of CSF flow at any given point.
  • the interior of the shunt system is provided with a reflective coating material so as to not absorb laser energy and prolong shunt life.
  • a nerve stimulating electrode may be used in conjunction with the angioscope.
  • the shunt is provided with an external conduit system for the delivery of antibiotics and other therapeutic substances to the tissues surrounding the shunt.
  • the tissues surrounding the shunt installation location do not receive much circulation. Accordingly, delivery of antibiotics and other drugs intravenously is not generally effective.
  • the external conduit of the present shunt which runs parallel to the tubing of the shunt, can carry such therapeutic substances to the various regions surrounding the shunt and deposit them in the tissues through openings in the conduit. Again, access to the external conduit is provided through the external access opening of the portal area.
  • the shunt of the present invention provides a much needed improvement in shunt revision.
  • FIGURE 1 there is shown one embodiment of the CSF shunt 20 of the present invention as installed in the skull of a child.
  • the shunt 20 comprises a ventricle tube 22, an elbow 24 located at the "corner" of the inverted L-shaped shunt 20, a portal region 26, a drain tube 30 and a long catheter 32 for draining the cerebrospinal fluid into a suitable body cavity.
  • the ventricle tube 22 of the shunt 20 extends at an approximately 90° angle from the drain tube 30 portion thereof into one of the ventricles of the brain of the patient as illustrated best in FIGURE 2.
  • FIGURE 2 is exemplary only.
  • ventricle tube 22 of the shunt 20 comprises a series of holes 21 or other openings to receive cerebrospinal fluid into the shunt 20 for purposes of draining to other body cavities. Draining is facilitated, in some embodiments, by means of a pump tube 31 which comprises a portion of the drain tube 30.
  • the drain tube 30 is situated subcutaneously (e.g., just below the skin) and behind the ear of the patient.
  • the physician is able to manipulate this pump tube 31 in order to modify the flow rate of cerebrospinal fluid and, in some instances, to clear obstacles.
  • the present invention comprises substantial improvement over a pump tube 31 in terms of clearing obstacles or other impediments to cerebrospinal flow.
  • the shunt 20 of the present invention receives cerebrospinal fluid into the ventricle tube 22 and drains it, via the elbow 24, drain tube 30 and catheter 32, to other body cavities where it can be safely eliminated from the body in accordance with normal waste removal functions.
  • an important advantage of the present invention is the facility of shunt 20 revision on a minimal invasive basis, clear drain obstacles and improve cerebrospinal flow, without major surgical intervention.
  • FIGURE 2 there is illustrated the placement of the elbow 24 of the shunt so as to be close to the surface of the skin, thereby providing access to the shunt 20 from external regions.
  • the shunt 20 is illustrated in more detail in the partial cross-sectional view of FIGURE 3.
  • FIGURE 3 there is shown the ventricle tube 22 attached at its distal end 23 to the elbow 24, which is in turn attached to the proximal end 29 of the drain tube 30.
  • the distal end 33 of the drain tube 30 is attached to one end of the catheter 32.
  • the elbow 24 of the present shunt 20 can be provided with connection systems at both of its branches which are well known by those of ordinary skill in the art.
  • the ventricle tube 22 and the drain tube 30 are connected to the branches 25 of the elbow 24 by means of a friction fit as shown in FIGURE 3.
  • other suitable connection mechanisms, such as connector devices, etc. are equally applicable.
  • the corner of the elbow 24 is provided with a portal 26 comprising a valved access opening which is described below in more detail in connection with FIGURES 5-8.
  • the ventricle tube 22 has a internal diameter of approximately 1.5-2.0 millimeters, or other diameters sufficient to accommodate a 0.5 millimeter angioscope, as explained below in more detail.
  • the length of the ventricle tube 22 is determined by the age of the patient.
  • the other branch 25 of the elbow 24 is connected to a drain tube 30 which includes a pump tube 31, mentioned above, and an external conduit 54 for providing therapeutic medications to the tissue surrounding the shunt 20.
  • the drain tube 30 also includes a one-way valve 36, as shown in FIGURE 3, which prevents the backflow of cerebrospinal fluid, as described below in more detail in connection with FIGURES 4 and 4a.
  • a drain tube 30 which includes a pump tube 31, mentioned above, and an external conduit 54 for providing therapeutic medications to the tissue surrounding the shunt 20.
  • the drain tube 30 also includes a one-way valve 36, as shown in FIGURE 3, which prevents the backflow of cerebrospinal fluid, as described below in more detail in connection with FIGURES 4 and 4a.
  • many configurations and structures relating to the drain tube 30 are within the principles of the present invention.
  • the external conduit 54 comprises an external lumen which runs parallel along the length of the drain tube 30.
  • the external conduit 54 is virtually coextensive with the drain tube 30; however, other configurations are possible, and it is even within the scope of the present invention that the external conduit 54 extend along the length of the catheter 32.
  • the external conduit 54 contains a number of openings 56 along its length such that antibiotics or other medications injected into the external conduit 54 through the portal 26 (in a manner described below in more detail in connection with FIGURE 6) will be carried along the length of the shunt 20, and drained externally into the surrounding tissues for therapeutic purposes.
  • FIGURES 4 and 4a illustrate the function of the one-way valve 36 of the present shunt, sometimes referred to as a duck bill type valve.
  • This valve 36 is located distally with respect to the drain end 30 of the elbow 24 and allows fluid to naturally pass only in one direction; that is, from the elbow 24 through the drain tube 30 and into the catheter 32.
  • the valve 36 is constructed such that it opens automatically when the pressure differential between the elbow 24 and the catheter 32 becomes great enough.
  • the valve 36 may be opened manually as well by transmission of pressure through the skin. That is, the valve 36 is molded as part of the drain tube 30 so that when the drain tube is pressed manually, the valve 36 will automatically open as shown in FIGURE 4a.
  • valves 36 are common in the previous shunts, it will be noted that the methodology of the present invention includes the passage of angioscopes and other instruments through this one-way valve 36 for distal inspection and corrective procedures. Thus, it is preferred that any such valves 36 provide a valve open diameter of at least 0.5 millimeter or more.
  • a catheter 32 portion of the shunt 20 is located at the distal end 33 of the drain tube 30 and extends under the skin to a site to which the fluid is shunted.
  • the catheter 32 as well known in the art, is a section of tubing which also may include one or more one-way valves (not shown). Again, preferably, the internal diameter of the catheter 32 should be at least 0.5 millimeters or greater in order to accommodate a suitable angioscope.
  • FIGURE 5 is a close-up cross-sectional view of the elbow 24 portion of FIGURE 3. As shown in FIGURE 5, suitable friction fit connections can be made at both branches 25 of the elbow 24 in order to attach the ventricle 22 and drain tubes 30 thereto. It will be noted that, in connection with the drain tube 30, a double lumen connector is necessary in order to accommodate the therapeutic conduit 54 described above.
  • FIGURES 5 and 6 illustrate the portal 26 region of the elbow 24, comprising the valved access opening including the dual-slit 46, 47 access openings, one for the main shunt 20 access and one for the external conduit 54 access.
  • These valve openings 46, 47 are shown in more detail in FIGURE 6, which is a front view of the portal 26 as taken along lines 6-6 of FIGURE 5.
  • the portal 26 is mounted at the bend in the elbow 24.
  • the portal 26 comprises a concave valve 44 having first and second slits 46, 47 located therein, and a portal cover 48.
  • the portal 26 is preferably mounted to the bend of the elbow 24 such that a trocar or other device may be inserted through it and directly into either branch of the elbow in a straight line. Normally, therefore, the portal 26 is mounted perpendicular to an imaginary line which bisects the center line of the branch of the elbow 24.
  • the concave valve 44 is, as best illustrated in FIGURE 6, a slit valve formed from a concave disc.
  • the slit 46 of the concave valve 44 is preferably oriented horizontally, as shown, but may also be oriented vertically in order to provide improved lateral access and movement for an angioscope 64, as described below in more detail.
  • the valve 44 be a four-quartered or four-flapped valve in order to enhance access and manipulation of the angioscope.
  • the concave valve 44 may be formed directly as part of the elbow 24, or it may be formed separately and then securely affixed to the elbow 24 with adhesive. While it is preferred that the valve be concave, it is possible for the valve to be flat or even convex.
  • the concave valve 44 is preferably made from silastic® so that it is sturdy, yet somewhat flexible.
  • the first slit 46 is placed in the middle of the valve 44 to allow access through the valve 44 to the inside of the elbow 24.
  • the slit 46 is sufficiently long to accommodate such items as trocars, angioscopes and the like.
  • the flexibility of the valve 44 allows it to accommodate the manipulation of the angioscope 64 as it performs its inspection and cleaning function in both the ventricle 22 and drain tube 30.
  • a second slit 47 is located below the first slit 46 and provides access to the external conduit 54.
  • the portal cover 48 is a membrane covering the concave valve 44.
  • the portal cover 48 is a self-sealing seal preferably made from silicone or other biocompatible material so that it is very elastic.
  • the portal cover 48 is stretched across the open side of the concave valve 44.
  • the cover 48 may be attached to the concave valve 44 by gluing or other attachment means well known in the art.
  • the portal cover 48 is preferably attached so that when a trocar or cannula is removed from it, the cover 48 returns to its original closed state.
  • the portal it is not absolutely necessary for the portal to have a cover 48. However, the risk of leakage through the portal 26 from the shunt 20 is greatly increased if a cover is not provided. It is also possible that only a portal cover 48 and no concave valve 44 be used.
  • the external conduit 54 is accessed through the portal 26, as noted above.
  • the inside of the external conduit 54 may be accessed by piercing the portal cover 48 and opening the second slit valve 47.
  • the external conduit 54 allows the passage of fluid, such as antibiotics, through it and out the drain holes 56 into the surrounding tissue. Access and injection into the conduit may be accomplished by a hypodermic needle.
  • a method of use of the present invention including the means of use of the portal 26 thereof may be described in connection with FIGURES 7-8.
  • the shunt 20 is installed in the fashion well known in the art. However, careful attention is given to the elbow 24 and portal 26 to ensure that the portal 26 is placed near the surface of the skin and oriented so that the skin and portal cover 48 are substantially parallel. Once in place, this shunt 20, like others, is located completely under the skin so as not to be visible or otherwise accessible without penetration of the skin.
  • Access to the inside of the shunt 20 is accomplished by, first, inserting a trocar 60, such as a 18-gauge needle, first through the skin covering the portal 26.
  • the portal 26 may be located through use of an X-ray and digital pressure.
  • the slit valve 46 is pressed open by pressing the concave valve 44 with fingers. The pressure is provided on the outside of the scalp, and transmitted to the slit 46. Pressure on the concave valve 44 aids in opening the slit 46 so that the trocar 60 may be passed therethrough.
  • the trocar 60 may be pushed through the elastic portal cover 48, through the slit 46 and into the inside of the elbow 24.
  • a cannula 62 may be slipped over it and guided into the shunt 20.
  • the direction at which the trocar 60 penetrates the portal 26 is important. Since the portal 26 is mounted on the bend or corner of the elbow 24, either branch of the elbow 24 may be accessed, depending on the entry angle of the trocar 60. As can be seen in FIGURES 7 and 8, the trocar 60 should pierce the portal 26 so that the trocar is parallel to the branch 25 in which it is to be inserted. It will be noted that the portal 26 design of the present invention, trocar 60 and angioscopic 64 access are available to either branch of the elbow without removing the trocar or angioscope. Therefore, the physician is able to inspect and perform corrective procedures in either the ventricle 22 or the drain 30 tube, including the catheter 32. This is an important advantage of the present invention which greatly facilitates shunt 20 revision.
  • the elbow cross section at the corner, can be made wider in order to permit trocar/angioscopic manipulation without contact to the internal surfaces of the shunt 20, thereby avoiding damage thereto and prolonging shunt life.
  • the portal 26 may be constructed with a flat valve or even convex valve in order to increase the manipulation space inside the elbow 24.
  • the portal 26 is situated to the outside portion of the elbow 24 near the skin. Therefore, the cerebrospinal fluid is not likely to leak out of the valve 44 opening of the elbow 24 since the force of gravity will cause it to immediately drain downwardly upon reaching the corner of the elbow 24. However, even if fluid does reach the slit valve 44 of the portal 26, the slit construction and the flaps of the valve 44 will prevent leakage. Leakage can fully be prevented by a portal cover 48, as explained above.
  • a variety of devices may be inserted through the cannula.
  • a .5 mm angioscope 64 may be used, depending on the exact inner dimensions of the shunt 20.
  • a .5 mm angioscope 64 is preferred since it requires a small cannula 62 for insertion, may easily be passed through the valves 36 in the shunt 20, and may easily be maneuvered.
  • the angioscope 64 may be used to view the inside of the shunt to check for valve malfunction, separation of any of the various component parts of the shunt, or blockage in any area of the shunt.
  • One such angioscope 64, having an internal lumen 66, is shown in FIGURE 9.
  • Angioscopes 64 of this type are fairly common in the prior art and within the knowledge of a person of ordinary skill.
  • angioscope 64 can be used in combination with other instruments which are inserted into the shunt 20 through the lumen 66 of the angioscope.
  • an excimer laser 68 can be inserted through the angioscope 64 and used to destroy choroid plexus, which often grows into the proximal end of the ventricle tube.
  • a hot-film anemometer (not shown) may be extended from the angioscope 64 into the shunt 20 at various locations in order to measure the flow rate of the cerebrospinal fluid.
  • an irrigation system 70 fitted to the angioscope 64 is particularly useful in introducing various fluids and antibiotics into the shunt 20. This is particularly useful since many infections manifest themselves inside the shunt 20 itself.
  • a snipping device 72 as shown in FIGURE 11, can also be utilized in connection with the angioscope 64 to remove blockages.
  • the operating condition of the shunt 20 may easily be examined and evaluated, without the need to remove or expose the shunt. Further, blockages and other problems may easily be remedied without the time and cost associated with replacing a non-functioning shunt.
  • the external conduit 54 is separately accessed through the portal 26. It is preferred that any cannula 62 or trocar 60 inserted into the shunt 20 be removed from the portal 26 before the external conduit 54 is accessed. If more than one cannula 62 or trocar 60 is inserted into the portal, the portal cover 48 may tear, causing the seal to be broken.
  • the external conduit 54 is accessed by inserting a trocar 60, preferably appropriately sized needle, into the scalp. Pressure is exerted on the scalp surrounding the trocar to open the second slit 47 in the concave valve 44. Once open, the trocar 60 may be pressed into the external conduit 54 through the portal cover 48 and the second slit 47. Once in place, antibiotics may be introduced into the external conduit 54. The antibiotic will travel down the external conduit 54, exiting into the tissue surrounding the shunt 20 through the drain holes 56.
  • a trocar 60 preferably appropriately sized needle
  • the portal seals itself securely, preventing the release of fluid from the shunt 20 into the surrounding tissue, or vice versa. This is because when the trocar 60 or cannula 62 is removed, the slits 46, 47 automatically close, and the portal cover 48 elastically rebounds to a sealed state.
  • the shunt 20 of the present invention can be constructed from any suitable biocompatible material well known to those of ordinary skill in the art.
  • the inside surfaces of the shunt 20 be lined with a material which is smooth and reflective. In this fashion, friction between the various instruments inserted into the shunt will be reduced.
  • the light emanating from the angioscope 64 will be reflected in order to improve the vision in the deeper regions of the shunt 20.
  • the interior of the shunt 20 system can be treated with a suitable coating so that laser energy is not absorbed, thereby prolonging the life of the shunt.

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Claims (10)

  1. Dispositif de dérivation (20) pour liquide céphalo-rachidien, ledit dispositif comprenant :
    un tube ventriculaire (22) conçu pour être inséré à travers le crâne et dans un ventricule d'un malade, ledit tube ventriculaire (22) ayant des ouvertures (21) destinées à recevoir ledit liquide céphalo-rachidien dans ledit tube ventriculaire (22) pour drainer ledit liquide céphalo-rachidien jusqu'à un autre site; un tube de drainage (30) en communication de fluide avec ledit tube ventriculaire (22) pour drainer ledit liquide céphalo-rachidien jusqu'à un autre site chez le malade, ledit tube de drainage (30) ayant des ouvertures (32, 36) pour permettre le drainage dudit liquide céphalo-rachidien hors dudit dispositif de dérivation (20); où ledit tube ventriculaire (22) et ledit tube de drainage (30) sont réunis en formant un angle (24) l'un par rapport à l'autre, caractérisé en ce qu'une ouverture d'accès munie d'une valve (26) est située audit angle (24) pour permettre l'accès externe pour un dispositif d'endoscopie (60-72) en vue de l'examen et du nettoyage dudit dispositif de dérivation (20), et pour offrir un accès externe audit tube de drainage (30) et audit tube ventriculaire (22), de façon que ledit dispositif d'endoscopie (60-72) puisse être inséré en ligne droite par ladite ouverture d'accès munie d'une valve (26) soit dans le tube ventriculaire (22) soit dans le tube de drainage (30).
  2. Dispositif de dérivation selon la revendication 1, où ledit tube de drainage comprend en outre un conduit externe (54) destiné à recevoir des produits thérapeutiques et des ouvertures (56) sont ménagées dans la paroi du conduit externe (54) pour permettre auxdits produits thérapeutiques de s'échapper dans les tissus entourant ledit dispositif de dérivation (20).
  3. Dispositif de dérivation selon la revendication 2, où ledit tube de drainage (30) est sensiblement parallèle audit conduit externe (54) et en fait partie intégrante sur au moins une portion.
  4. Dispositif de dérivation selon l'une quelconque des revendications 1 à 3, où ladite ouverture d'accès munie d'une valve comprend une valve d'accès (44) comprenant une valve fendue ré-obturable (46) en une matière élastique ayant une surface spécifique relativement importante, ladite surface spécifique permettant l'accès pour ledit dispositif d'endoscopie (60-72) audit tube ventriculaire (22) et audit tube de drainage (30).
  5. Dispositif de dérivation selon la revendication où ladite valve (44) en ladite matière élastique comprend une structure concave.
  6. Dispositif de dérivation selon l'une quelconque des revendications 1 ou 3, où ladite ouverture d'accès munie d'une valve est dotée d'un couvercle (48).
  7. Dispositif de dérivation selon l'une quelconque des revendications 1 à 6, où le diamètre interne dudit dispositif de dérivation (20) est compris dans l'intervalle de 1,5 à 2 mm.
  8. Dispositif de dérivation selon l'une quelconque des revendications 1 à 7, où les surfaces internes dudit dispositif de dérivation (20) sont revêtues d'une matière qui n'absorbe pas la lumière, la lumière laser n'endommageant donc pas ledit dispositif de dérivation (20).
  9. Dispositif de dérivation selon l'une quelconque des revendications 4 à 8, où ladite valve d'accès (44) comprend une seconde valve fendue (47), ladite seconde valve fendue (47) étant en communication de fluide avec ledit conduit (54) pour permettre l'introduction dans ledit conduit (54) de substances thérapeutiques.
  10. Dispositif de dérivation selon la revendication 9, où ladite première et ladite seconde valves fendues (46, 47) sont sensiblement auto-obturables.
EP93910608A 1992-04-24 1993-04-15 Derivation du liquide cephalo-rachidien permettant un controle invasif minimal Expired - Lifetime EP0637971B1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US874293 1986-06-13
US07/874,293 US5385541A (en) 1992-04-24 1992-04-24 Cerebrospinal fluid shunt capable of minimal invasive revision
PCT/US1993/003546 WO1993021973A1 (fr) 1992-04-24 1993-04-15 Derivation du liquide cephalo-rachidien permettant un controle invasif minimal

Publications (2)

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EP0637971A1 EP0637971A1 (fr) 1995-02-15
EP0637971B1 true EP0637971B1 (fr) 1997-12-10

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US (1) US5385541A (fr)
EP (1) EP0637971B1 (fr)
CN (1) CN1081622A (fr)
AT (1) ATE160945T1 (fr)
AU (1) AU4104193A (fr)
DE (1) DE69315688D1 (fr)
WO (1) WO1993021973A1 (fr)

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Publication number Publication date
EP0637971A1 (fr) 1995-02-15
WO1993021973A1 (fr) 1993-11-11
ATE160945T1 (de) 1997-12-15
CN1081622A (zh) 1994-02-09
AU4104193A (en) 1993-11-29
US5385541A (en) 1995-01-31
DE69315688D1 (de) 1998-01-22

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